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Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses: A Randomized Clinical Trial.


ABSTRACT: IMPORTANCE:Many preschool children develop recurrent, severe episodes of lower respiratory tract illness (LRTI). Although viral infections are often present, bacteria may also contribute to illness pathogenesis. Strategies that effectively attenuate such episodes are needed. OBJECTIVE:To evaluate if early administration of azithromycin, started prior to the onset of severe LRTI symptoms, in preschool children with recurrent severe LRTIs can prevent the progression of these episodes. DESIGN, SETTING, AND PARTICIPANTS:A randomized, double-blind, placebo-controlled, parallel-group trial conducted across 9 academic US medical centers in the National Heart, Lung, and Blood Institute's AsthmaNet network, with enrollment starting in April 2011 and follow-up complete by December 2014. Participants were 607 children aged 12 through 71 months with histories of recurrent, severe LRTIs and minimal day-to-day impairment. INTERVENTION:Participants were randomly assigned to receive azithromycin (12 mg/kg/d for 5 days; n?=?307) or matching placebo (n?=?300), started early during each predefined RTI (child's signs or symptoms prior to development of LRTI), based on individualized action plans, over a 12- through 18-month period. MAIN OUTCOMES AND MEASURES:The primary outcome measure was the number of RTIs not progressing to a severe LRTI, measured at the level of the RTI, that would in clinical practice trigger the prescription of oral corticosteroids. Presence of azithromycin-resistant organisms in oropharyngeal samples, along with adverse events, were among the secondary outcome measures. RESULTS:A total of 937 treated RTIs (azithromycin group, 473; placebo group, 464) were experienced by 443 children (azithromycin group, 223; placebo group, 220), including 92 severe LRTIs (azithromycin group, 35; placebo group, 57). Azithromycin significantly reduced the risk of progressing to severe LRTI relative to placebo (hazard ratio, 0.64 [95% CI, 0.41-0.98], P?=?.04; absolute risk for first RTI: 0.05 for azithromycin, 0.08 for placebo; risk difference, 0.03 [95% CI, 0.00-0.06]). Induction of azithromycin-resistant organisms and adverse events were infrequently observed. CONCLUSIONS AND RELEVANCE:Among young children with histories of recurrent severe LRTIs, the use of azithromycin early during an apparent RTI compared with placebo reduced the likelihood of severe LRTI. More information is needed on the development of antibiotic-resistant pathogens with this strategy. TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT01272635.

SUBMITTER: Bacharier LB 

PROVIDER: S-EPMC4757487 | biostudies-literature | 2015 Nov

REPOSITORIES: biostudies-literature

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Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children With a History of Such Illnesses: A Randomized Clinical Trial.

Bacharier Leonard B LB   Guilbert Theresa W TW   Mauger David T DT   Boehmer Susan S   Beigelman Avraham A   Fitzpatrick Anne M AM   Jackson Daniel J DJ   Baxi Sachin N SN   Benson Mindy M   Burnham Carey-Ann D CD   Cabana Michael M   Castro Mario M   Chmiel James F JF   Covar Ronina R   Daines Michael M   Gaffin Jonathan M JM   Gentile Deborah Ann DA   Holguin Fernando F   Israel Elliot E   Kelly H William HW   Lazarus Stephen C SC   Lemanske Robert F RF   Ly Ngoc N   Meade Kelley K   Morgan Wayne W   Moy James J   Olin Tod T   Peters Stephen P SP   Phipatanakul Wanda W   Pongracic Jacqueline A JA   Raissy Hengameh H HH   Ross Kristie K   Sheehan William J WJ   Sorkness Christine C   Szefler Stanley J SJ   Teague W Gerald WG   Thyne Shannon S   Martinez Fernando D FD  

JAMA 20151101 19


<h4>Importance</h4>Many preschool children develop recurrent, severe episodes of lower respiratory tract illness (LRTI). Although viral infections are often present, bacteria may also contribute to illness pathogenesis. Strategies that effectively attenuate such episodes are needed.<h4>Objective</h4>To evaluate if early administration of azithromycin, started prior to the onset of severe LRTI symptoms, in preschool children with recurrent severe LRTIs can prevent the progression of these episode  ...[more]

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